Intended for healthcare professionals

Information In Practice

Why general practitioners use computers and hospital doctors do not—Part 2: scalability

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7372.1090 (Published 09 November 2002) Cite this as: BMJ 2002;325:1090

Why hospital doctors don’t use computers

We would like to add some considerations to Benson’s analysis
reported in BMJ last November (1-2) about the unwillingness to using
computers by doctors in hospitals. Our experience on Computerised
Physician Order Entry (cPOE) may be of help in understanding the current
limitations in the widespread use of computers in daily hospital practice.

In June 2000, the Infectious Diseases Unit of Ospedali Riuniti di
Bergamo (46 beds, 13 physicians and 24 nurses) started a program aimed at
implementing a software package, running on PCs and palm pilot devices,
for flexible and secure management of therapies at patient’s bedside. The
software package has been tested for one year and since June 2001 the
system has been routinely applied at our Unit, for in-patient drug
prescription. Users perceived the system as an improvement compared with
traditional hand-write prescription (HWP). An assessment questionnaire
revealed that none of the physicians and nurses would revert back to the
old HWP.

In order to assess the reproducibility of these results, a pilot
experience has been extended to 12 other Infectious Diseases Units in
Italy. The study ended a few weeks ago and a preliminary analysis is
available. The number of beds in each Unit ranged from 12 to 32 and 64
doctors with 123 nurses were involved. A total of 10% of doctors and 40%
of nurses reported they had never used PCs. The number of PCs for each
single unit varied from 2 to 20 and they were connected to the hospital
network in 7 units only. More than 80% of health care workers using HWP
perceived readability of prescriptions and the related administrative
burden as relevant problems, but only 55% believed that HWP could be a
source of errors.

After the preliminary training, 6 out of 12 units started cPOE and
only 3 completed the 4-month study test. Of them, two units are currently
using cPOE as a routine, while one Unit reverted back to HWP as cPOE was
perceived as more time consuming. The main reason, according to users, for
non starting cPOE or discontinuing during the test was a low level of
collaboration among staff members, which is in line with what reported by
Benson (2). Technical problems, hardware limitations and insufficiently
familiarity with PCs were reported, but seemed to be marginal.

Therapy management in hospital setting is time consuming, requires
frequent variations, involves both doctors and nurses and causes errors
(3). Reducing errors is the main reason for electronic prescription of
therapies, but implementing a new system as cPOE requires strong efforts
which will be endorsed if they are perceived as convenient by both nurses
and clinicians.

An additional answer to Benson’s question on reasons why hospital
doctors don’t use PCs may be the low level of perception of the risk of
error for HWP. In this regard, we think that educational investment has
priority on information technology expenditure to improve PC use in
hospital setting.

References

1)Tim Benson. Why general practitioner use computer and hospital
doctors do not-Part 1: incentives. BMJ 2002; 325:1086-9

2)Tim Benson. Why general practitioner use computer and hospital
doctors do not-Part 2: scalability. BMJ 2002; 325:1090-93

3)Schiff G. M, Rucker D. Bilding the Electronic Infrastructure for
Better Medication Usage in Computerized Prescribing. JAMA 1998; 279: 1024-
1029

The study was supported by unrestricted educational grant by
GlaxoSmithKline and Tecnical support by Roberto Altieri, Arakne, Roma

Competing interests:  
None declared

Competing interests: No competing interests

18 December 2002
Claudio Arici
MD
Diego Ripamonti, Fredy Suter. On behalf of Palmhospital Study Group
Infectious Diseases Unit, Ospedali Riuniti di Bergamo, 24100, Italy